Akuter Glaukomanfall an beiden Augen nach Glaukosantropfen

Ohne Zusammenfassung     

Glaukomanfall und Wetter

Zusammenfassung Es wurden Untersuchungen angestellt über die Zusammenhänge zwischen dem Auftreten akuter Glaukomanfälle und den Wetterverhältnissen in der Umgebung der Anfallstage. Die Vorbedingungen zu einer einwandfreien Beurteilung waren in 91 Fällen gegeben, die sich auf die Jahre 1932–1942 verteilen. Es ergab sich:In 78% der Fälle traf der Glaukomanfall mit dem Durchgang einer Wetterfront zusammen.Glaukomanfälle traten besonders häufig an Tagen mit hoher atmosphärischer Spannung auf. Definition dieses Begriffs im Text!In der Zeit unmittelbar nach dem Anfall findet sich ein steiles Abfallen der atmosphärischen Aktivität. Selten tritt ein Glaukomanfall an Tagen erdmagnetischer Ruhe auf.Zusammenhänge zwischen dem Auftreten von Glaukomanfällen und dem Verhalten des Luftdrucks sowie mit Regenfällen, Temperaturverhältnissen oder Gewittern konnten nicht festgestellt werden.Mit 4 Textabbildungen     

Erwiderung auf den Aufsatz: Akuter Glaukomanfall an beiden Augen nach Glaukosantropfen (Graefes Arch. 120, 514. 1928)

Zusammenfassung 1. ZurVerhütung des Anfalles ist nichts geschehen, obwohl ineiner Sitzungbeiderseits behandelt worden war.2. Bis zurBehandlung des Anfalles hat der Autor (obwohl der Patient klinisch aufgenommen, also jede Möglichkeit gegeben war) 5 Tage lang tatenlos abgewartet. Das ist ähnlich, wie wenn man bei einem eingeklemmten Bruch 5 Tage warten wollte.     

Tensioverhalten nach Einsatz dreier verschiedener Viskoelastika nach Kataraktoperation

Fragestellung: In einer prospektiven, randomisierten Studie soll überprüft werden, ob verschiedene Viskoelastika (adatocel^?, Amvisc^? Plus und Healon^?) einen unterschiedlichen postoperativen Augeninnendruck nach Phakoemulsifikation und IOL-Implantation hervorrufen.     

Tensioverhalten nach Einsatz dreier verschiedener Viskoelastika nach Kataraktoperation

By using three different viscoelastics [Adatocel (methylhydroxypropylcellulose), Amvisc Plus (sodium hyaluronate) and Healon (sodium hyaluronate)] a prospective randomized study was conducted to investigate whether postoperative intraocular pressure shows significant differences according to the viscoelastics used after 150 cases of cataract surgery. PATIENTS AND METHODS: The inclusion criteria for this study were: extracapsular cataract extraction via the usual small-incision techniques and endocapsular posterior-chamber lens implantation. A total of 150 eyes were operated upon. The patients were randomly assigned to three groups according to the viscoelastics, 50 cases used adatocel, 50 Amvisc Plus and 50 Healon. As far as possible, the viscoelastics were sucked out under visual control. Intraocular pressure (IOP) was measured after 6 and 24 h. RESULTS: Six hours postoperatively, no statistically significant difference between the intraocular pressure after using different viscoelastics (adatocel: 19.6 +/- 9.7 mmHg, Amvisc Plus: 20.5 +/- 9.6 mmHg und Healon: 21.8 +/- 8.8 mmHg) was seen. At 24 h IOP was statistically significant higher for Healon than for adatocel and Amvisc Plus (adatocel: 16.3 +/- 4.8 mmHg, Amvisc Plus: 16.5 +/- 4.6 mmHg and Healon: 19.7 +/- 6.6 mmHg). CONCLUSIONS: Six hours postoperatively after phacoemulsification there was no significant difference between the IOP using different viscoelastics adatocel, Amvisc Plus and Healon. Twenty-four hours postoperatively a significantly higher intraocular pressure was measured for Healon than for the other viscoelastics.     

Einjahresergebnisse nach LASEK

ZusammenfassungHintergrund Es wurden Ergebnisse der LASEK zur Korrektur von mittlerer Myopie und myopem Astigmatismus mit Hilfe der Refraktionsmatrix untersucht.Patienten und Methode In diese retrospektive Analyse wurden 54 myope Augen eingeschlossen, die mit LASEK behandelt und mindestens ein Jahr nachbeobachtet wurden. Durch 25–45 s lange Exposition der Hornhaut mit 20%igem Ethanol wurde ein Epithellappen mit superiorem Hinge präpariert. Die Stromaoberfläche wurde mit 2 verschiedenen Excimerlasern abladiert. Der Epithellappen wurde reponiert und eine Verbandslinse appliziert. Untersucht wurden die manifeste Refraktion mit der Matrixmethode nach Kaye, der unkorrigierte und der bestkorrigierte Visus und die Nachbehandlungsrate.Ergebnisse Die mittlere manifeste Refraktion zu den verschiedenen Zeitpunkten ist in Tabelle 1 dargestellt. Die unkorrigierte Sehschärfe betrug nach einer Woche in 33% der Augen und in der Zeit zwischen 3 Monaten und einem Jahr postoperativ in mehr als 53% der Fälle 1,0. Der Sicherheitsindex blieb mindestens bei 0,98 bei den Kontrollen nach einem Monat im ersten postoperativen Jahr. Der Effektivitätsindex im selben Zeitraum schwankte zwischen 0,91 und 0,98.Schlussfolgerung LASEK zur Korrektur der mittleren Myopie und des myopen Astigmatismus scheint eine sichere und effiziente Option zu sein.Förderung: New England Corneal Transplant Fund, Research to Prevent Blindness Lew R. Wasserman Merit Award und Massachusetts Lions Eye Research Award (DTA).     

Fadenmanagement nach Trabekulektomie

The frequency of bleb interventions after trabeculectomy is high. In half of the cases suture manipulation of the scleral flap is needed. Both standard and adjustable sutures are used for outflow adjustment of the scleral flap. The long-term results of both methods are equivalent. Open scleral flap revision and transconjunctival sutures are suitable for the treatment of hypotonia. Postoperative conjunctival suture removal seems to be favourable, improving both intraocular pressure and overall success rate.     

Sensorik nach Makulatranslokation

Kompensationsmechanismen nach Makulatranslokationen k?nnen unter monokularen Bedingungen spontan einsetzen. Hier gelingt die zentrale Umwertung der Netzhautmeridiane. Bei sehr gro?winkligen Translokationen oder unter binokularen Bedingungen sind jedoch zur Herbeiführung von Beschwerdefreiheit gegenrotatorische Ma?nahmen erforderlich. Damit postoperativ Binokularsehen wiederhergestellt werden kann, sollte der vermutlich maximal fusionierbare Restwinkel von 7–8° Restzyklodeviation nicht überschritten werden.     

Funktionstraining nach MIOL-Implantation

In a prospective and intraindividually comparative study, we investigated visual performance after implantation of two multifocal intraocular lenses. Eight patients received the ReSTOR (Alcon) bilaterally, and eight patients received the Tecnis ZM900 (AMO). The nondominant eye of each patient was trained based on the concept of perceptual learning using orientation discrimination of near-vertical bars. The fellow eye served as a control.After 3 h of training distributed over 2 weeks, the mean improvement of orientation discrimination in the trained eyes was 44%, which was significantly higher compared with the control eyes (9%). Moreover, contrast sensitivity and near vision under different contrast levels showed a significant benefit of training. These results support the concept of improving visual function by training after multifocal lens implantation. The superior function of the trained eyes was still present at the 6-month follow-up.     

Sensorik nach Makulatranslokation

Following macular translocation, spontaneous compensation of subjectively felt tilt can occur by central adaptation to the rotation of the retinal meridians. However, in cases of large angle rotations or under binocular conditions, efforts to counter-rotate the globe have to be made in order to achieve comfortable vision. For restoring binocular vision postoperatively, the fusionable residual angle of 7-8 degrees should not be exceeded.     

Glaucom nach Linear-Extraction

Ohne Zusammenfassung     

Pupillomotorik nach Kataraktoperation

Fragestellung: Ziel der vorgelegten Studie ist es, den Einflu? der Operation auf die postoperativ spaltlampenmikroskopisch unauff?llige Pupille zu erfassen.     

Immunsuppression nach Keratoplastik

Corticosteroid eye drops are the mainstay of immunosuppressive therapy after routine lamellar and perforating corneal transplantation. Commonly occurring side effects are cataract formation and increased intraocular pressure. Alternative immunosuppressive agents could allow the dosage of glucocorticoids to be reduced. The antibiotic azithromycin is a candidate drug that showed anti-inflammatory properties in cell cultures and animal models and has positive effects on transplant rejection.     

Nachstarbildung nach Intraokularlinsenimplantation

The introduction of sharp-edged optics has drastically reduced, but not fully eradicated, retro-optical after-cataract formation. The effectiveness of capsular bending rings or primary posterior capsulorhexis is also limited, and these have not become widespread because of the demanding surgical technique and the costs associated with an additional implant. Anterior capsule polishing has been found to even increase the need for laser capsulotomy, and rinsing the sealed capsular bag with cell-toxic agents has not yet gained clinical application. Routine posterior optic buttonholing through a well-centered posterior capsulorhexis opening is a promising alternative because it precludes access of lens epithelial cells behind the optic while at the same time counteracting fibrosis of the anterior capsule. Because this effect is independent of optic rim design and lens material, future efforts in lens refinement may concentrate on reducing the reflectivity of the optic rim and optimizing the biocompatibility of the lens material.     

Ergebnisse nach Boston-Keratoprothese

Background

The Boston keratoprosthesis (BKP) is a surgical therapeutic option in patients with corneal disease and poor prognosis for penetrating keratoplasty. The purpose of this study was to summarize our results with this surgical technique which we have employed at our institution since November 2009.

Methods

All patients who underwent the BKP procedure at our institution between November 2009 and August 2011 were identified retrospectively and the data were analyzed. The surgical procedure and postoperative treatment were performed following the recommendations of the developers of the BKP.

Results

A total of 14 patients were included in the study and the patient age ranged from 36 to 78 years. All patients had superficial and stromal corneal opacification with loss of the normal corneal surface (conjunctivalization). In 13 patients the BKP was implanted after at least 1 penetrating keratoplasty (including 3 matched grafts) and in 1 patient it was performed as a primary procedure. The underlying diseases were Stevens-Johnson syndrome, chemical injury, chronic atopic dermatitis in neurodermitis, keratoconus, granulomatous uveitis, congenital glaucoma and eyeball injury/burn. The follow-up ranged from 1 to 21 months. Postoperative complications consisted of prolonged inflammatory anterior chamber reaction with synechia, deposits on the intraocular lens, posterior capsule opacification, secondary glaucoma, hypotension, conjunctival growth over the keratoprosthesis and cystoid macular edema. All cases had overall improvement of visual acuity at the last follow-up visit. The maximum improvement was from counting fingers to 0.7.

Conclusion

Until now all BKPs have been preserved. At our institution the BKP is becoming increasingly more important even in such cases with a (very) poor prognosis for matched limbal and/or corneal grafts. Reimbursement for the BKP must, however be organized on a case by case basis.     

Astigmatismus nach Keratoplastik

Background

Patients undergoing corneal transplantation often suffer from postoperative reduced vision due to high astigmatism. This retrospective study analyzed the influence of heterotopic or orthotopic transplantation on astigmatism and visual outcome.

Patients and methods

In this study 373 eyes of 334 patients were analyzed. Group 1 (OT) contained 186 eyes, which underwent orthotopic transplantation (side of recipient and donor corresponded), whereas group 2 (HT) included 187 heterotopic keratoplasties (donor cornea placed in the recipient’s contralateral side). After 1, 3, 6, 12 and 24 months the median of keratometric astigmatism, objective astigmatism, topographic astigmatism and best corrected visual acuity (BCVA) were assessed and compared between groups.

Results

The long-term results showed no statistically significant differences regarding keratometric and objective astigmatism, whereas topographic astigmatism differed significantly (p?=?0.04) after 3 months. We observed a lower astigmatism of 5.7 dpt (range 3.08-7.78 dpt) in group OT than in the group HT with 7.1 dpt (range 3.9-10.7 dpt). No differences were found at the other time points. The BCVA showed a significantly better effect after 1 month (p?=?0.01) in the OT group of 0.2 (0.1-0.3) than in HT group of 0.1 (0.05/0.25). In the postoperative course no additional significant dissimilarities were documented.

Conclusions

Heterotopic and orthotopic keratoplasty show no significant long-term differences in astigmatism and visual outcom.     

Pupillomotorik nach Kataraktoperation

BACKGROUND: The goal of a cataract operation is to achieve an optimal outcome, which includes a round and functioning pupil. The goal of this study was to analyze the influence of cataract operations on pupils that appear to be normal on slit-lamp examination postoperatively. PATIENTS AND METHODS: A videopupillography was performed on 47 eyes of 47 patients after phacoemulsification without complications in the first eye, and on 12 eyes of 12 patients after phacoemulsification without complications in the second eye. RESULTS: After surgery, the first eyes showed a significantly more constricted pupil compared to the non-operated eye independently of the stage of irritation. After surgery of the second eye, this was only observed under near dark conditions. CONCLUSION: Even the morphologically normal pupil shows a change in motility postoperatively. We believe that the reason for this is the mechanical manipulation of the iris during cataract operation. During this, the sensitive dilator muscle of the pupil is affected, leading to temporary or permanent changes in pupillary function. The change in motility of the contralateral, non-operated eye cannot be easily explained. The pupil size is important for the visual process and alteration of its function allows an evaluation of the quality of the operation.